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Matt Weir & I offer an obituary of our affable colleage George Bakris ahajournals.org/doi/abs/10.116… "With a diagnosis of cancer 4 years ago, pain was inevitable. But how to respond to this crisis was a choice. Dr Bakris inspired us by publishing >200 papers while battling his disease."

Heart failure survival curves start separating within days of using finerenone. Whereas heart failure benefits are seen early, kidney failure benefits in T2D take 18 months to manifest.

nature.com/articles/s4159… Among nearly 19K patients across 3 high risk populations--FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF--finerenone reduced the risk of all-cause mortality by 9%. (HR 0.91; 95% CI 0.84-0.99; P = 0.027) Muthu Vaduganathan

nature.com/articles/s4158……

Evidence is thin that hypertension causes chronic kidney disease. academic.oup.com/ndt/advance-ar…

There is an unmet need in managing diabetic kidney disease, as these patients often experience cardio-renal-metabolic complications. The CONFIDENCE trial explores the combination of SGLT2 inhibitors and a novel MRA for this patient population. Rajiv Agarwal MD, MS World Congress of Nephrology #ISNWCN

CONFIDENCE trial: Baseline clinical characteristics announced at WCN and published in NDT. Broad representation from around the globe including 45% Asians, 10% Hispanics, and 8% Blacks. academic.oup.com/ndt/article/do…

Late breaking clinical trials I: EDTA ERA Jun 5, 2025 11:15 AM to 12:45 PM CEST. era-apps.m-anage.com/era25/en-GB/pa… CONFIDENCE examines the simultaneous initiation of empagliflozin plus finerenone and compares them to empagliflozin or finerenone alone. academic.oup.com/ndt/article/38… NDT

“What’s Old is New Again!” - C. Michael Gibson MD The MR / aldosterone axis remains in central focus for the *treatment* and now *prevention* of heart and kidney disease in 2025

Exciting!, only 2 more ‘sleeps’ until the results of the CONFIDENCE trial cc: Rajiv Agarwal MD, MS ERA - European Renal Association for all those who celebrate, 👀🤓😃🙏💛 #nephjc #ERA25

It is rare where expectations are exceeded in kidney clinical trials. Correct answer is 52%. Only 80% of people thought it would be less.

More than 50% reduction in uacr with combo and about 30% with each component that is empagliflozin and finerenone. Time to consider simultaneous initiation of combination therapy in ckd and t2d as in hfref and stage 2 hypertension.

Yes, you are correct. By withdrawing treatment at the end of study we show that albuminuria reduction disappears, which is why patients need to be on treatment for life or if they get to dialysis. It simply proves that this is not a cure.

🆕CONFIDENCE trial 📌 Among persons with both CKD ➕ T2D👉therapy with finerenone plus empagliflozin led to a greater reduction in urinary ACR than either alone pubmed.ncbi.nlm.nih.gov/40470996/ #ERA25 Rajiv Agarwal MD, MS VA by Edgar V. Lerma 🇵🇭

Inside story from Rajiv Agarwal MD, MS: #CONFIDENCE done in 2 parts because of early safety concerns re simultaneous SGLT2i & nsMRA 🔹 Part A: higher GFR with ABPM after first dose 🔹 Part B: Main study without ABPM after 👍 from DSMB hcplive.com/view/kidney-co… #KidneyCompass #ERA25

Steroidal or nonsteroidal mineralocorticoid receptor antagonists for reducing CVD in CKD kidney-international.org/article/S0085-…

At ERA meeting in Vienna >10,000 people attended from 128 countries! top attendance ->USA. Nearly 4000 participants witnessed the late breaking clinical trials, the highlight of the congress. Thank you! ERA - European Renal Association Roser Torra Christoph Wanner